Provider Demographics
NPI:1891386934
Name:ASHKAN KHOSHROU D.M.D. , INC
Entity Type:Organization
Organization Name:ASHKAN KHOSHROU D.M.D. , INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHKAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KHOSHROU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-584-2451
Mailing Address - Street 1:27150 ALICIA PKWY
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-3415
Mailing Address - Country:US
Mailing Address - Phone:949-584-2451
Mailing Address - Fax:
Practice Address - Street 1:27150 ALICIA PKWY
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-3415
Practice Address - Country:US
Practice Address - Phone:949-584-2451
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-01
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental